Request a Speaker

Contact Information

Requests for speakers must be made at least three weeks in advance of the desired visit date and are subject to availability.

Name:*

First Last

Organization:*

Primary Phone:*

Email*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Event Information

Event Name:*

Organization Hosting Event:*

Organization Website:

Type of Organization:*

Community organization
Environmentally focused organization
Water related industry
Business
School

Event Sponsor:

Date*

If multiple dates or flexible dates, please enter one date here and provide additional information at the bottom of the form.

Event Start Time:*

:

Speaker Start Time*

:

Total Time Allotted for Speaker:*

Event Address*

Street Address Address Line 2 City State ZIP Code

Presentation Type:*

Q&A Included

Yes
No

Topic Requested:*

Speaker Requested (If known):

Expected Audience Size*

Indicate Available Equipment*

Check all that apply

LCD projector
Computer with presentation software
Computer with speakers
Room can be darkened
Internet access
None available

Are There Funds to Cover Travel Expenses if Necessary?*

Yes
No

Is an Honorarium Available?*

*Honorariums support the education and research mission of the School of Freshwater Sciences and will be placed in the Friends of Water account at the UWM Foundation. Honorariums are not required.

Yes
No

If yes, what is the amount of the honorarium?

Please provide any other information that may help clarify your request: